New Program Form New Program Form Step 1 of 6 – Program Information 16% Program Name: * RequiredProgram Director candidate: * RequiredAssociate/Assistant Program Director candidate:(if applicable)Program Coordinator candidate: * RequiredHow will having this program serve the patients within the UAMS system? * RequiredHow will having this program serve the patients of Arkansas * RequiredDescribe the protected time needed for educational and administrative responsibilities of the program for the program director (must meet the ACGME minimum requirements): * Required Does the PD candidate meet the following qualifications outlined by the ACGME:Requisite specialty expertise * Required Yes No Please explain:Documented educational experience * Required Yes No Please explain:Documented administrative experience * Required Yes No Please explain:Current certification in the specialty * Required Yes No List name and date of certificationsCertification NameDate of Certification Current medical licensure and appropriate medical staff appointment * Required Yes No Please explain:Meets specialty specific requirements for number of years as a faculty member in an ACGME-accredited program * Required(if applicable) Yes No Please explain:Meets specialty specific requirements for expected time for PD * Required(if applicable) Yes No Please explain: What is the PD candidates proposed term of appointment as PD? * Required <6 months Interim: >= 6 months and <2 years >2 years and <6 years Indefinite >6 years List all participating institutions of clinical sites to which the residents/fellows will rotate: * RequiredNameLocation At each participating site, are there sufficient number of faculty members with documented qualifications to instruct and supervise all residents at that location per ACGME requirements? * Required Core FacultyCore faculty is defined as physicians who devote at least 15 hours per week to resident education and administration. See specific program requirements for other qualifications of core faculty. PDs will not be designated as core faculty. List your core faculty * Required Given the identified core faculty, have you considered if they have enough scholarly activity to meet the requirements of your program. * Required Yes No How many of your core faculty have two or more articles published with PubMed IDs? * Required Number of articles published with PubMed IDs. * RequiredNumber of abstracts, posters, and presentations given at international, national, or regional meetings. * RequiredNumber of other presentations given (grand rounds, invited professorships), materials developed (such as computer-based modules), or work presented in non-peer review publications. Articles without PMIDs should be counted in this section. This will include publication which are peer reviewed but not recognized by the National Library of Medicine. * RequiredNumber of chapters or textbooks published. * RequiredNumber of grants for which faculty member had a leadership role (PI, Co-PI, or site director). * RequiredNumber of active leadership roles (such as serving on committees or governing boards) in national medical organizations or served as reviewer or editorial board member for a peer-reviewed journal. * RequiredNumber of faculty that held responsibility for seminars, conference series, or course coordination (such as arrangement of presentations and speakers, organization of materials, assessment of participants' performance) for any didactic training within the sponsoring institution or program. This includes training modules for medical students, residents, fellows and other health professionals. This does not include single presentations such as individual lectures or conferences. * Required Describe the full costs of the program. * RequiredPlease attach a proposed budget for 3 years of the program, including initial cost of starting a new program set by the ACGME ($6,800), cost of resident/fellow stipends (include 26% of stipend for benefits and liability insurance), faculty salary, outside speakers, research costs, recruitment costs, etc. Max. file size: 15 MB.Describe the source of resident/fellow stipends and benefits (UAMS, ACH, VA, other rotation sites). What hospital representative has agreed to this funding? * Required
